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General NPI Number Information
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NPI Number | 1861034225
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Entity Type | Organization
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Legal Business Name | NORTHEND VILLAGE NON-PROFIT
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Dates
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Enumeration Date | 10/16/2019
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Last Update Date | 01/31/2022
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Provider Practice Location Address
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Address Line | 8904 WOODWARD AVE
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City | DETROIT
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State | MI
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Zip | 48202-1821
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Country | US
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Telephone | 313-363-7018
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Fax | 248-608-8592
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Provider Business Mailing Address
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Address Line | 22745 CAMBRIDGE AVE
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City | DETROIT
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State | MI
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Zip | 48219-1725
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Country | US
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Telephone | 313-363-7018
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Fax | 248-608-8592
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Authorized Official
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Title or Position | MEMBER
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Name | BETTY MACKIE
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Credential |
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Telephone | 313-363-7018
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA0600X
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Taxonomy Name | Adult Day Care Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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